| NPI | 1770899247 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBIN GREENE Practice Administrator 757-962-6769 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401004149) |
| Enumeration Date | 2010-08-23 |
| Last Update Date | 2010-08-23 |